Overactive Bladder

An Overactive Bladder, also known as OAB, causes frequent and sudden urgens to urinate that may be difficult to control. There is an urge to pass urine many times during the day and night, and you may also experience unintentional loss of urine (urgency incontinence).

Causes of OAB include:

Increased intake of fluids (especially, coffee, tea, carbonated drinks containing caffeine), alcohol, fruits, vegetables; cool/rainy weather, indoors (especially with air-conditioning)

Anxiety, stress, habit or social voiding and psychiatric conditions (e.g. obsessive compulsive neurosis)

Certain medications like diuretics used to treat high blood pressure, heart, kidney or liver conditions, will increase urine production and cause frequent urination

Diabetes mellitus and diabetes insipidus - deficiency or absence of the hormone insulin and anti-diuretic hormone respectively, resulting in increased urine production and output

Urinary tract infection, menopause, pelvic organ prolapse, pelvic mass (uterine fibroid, ovarian cyst), bladder stone, bladder cancer, radiation treatment to bladder and pelvis, untreated heart failure, chronic cystitis, stress urinary incontinence, abnormal bladder contractions

The incidence of OAB increases with age, and it affects 11-22% of adults over 40 years old.

Symptoms include:

• Urgency (a sudden compelling desire to pass urine that is difficult to delay)
• With or without urge incontinence (uncontrollable leakage of urine accompanied by or immediately preceded by urgency)
• Usually with frequency (the need to pass urine too often in the day time) and nocturia (the need to wake up at night more than once to pass urine)

A diagnosis of an OAB would depend on the cause(s) of the OAB from your history and physical examination:

• Simple intake chart and urinary diary to record your fluid intake, urinary output and incontinence episodes
• Urine test(s) to diagnose urinary tract infection
• Bladder scan to diagnose high residual urine after you have just passed urine
• Pelvic scan to diagnose uterine fibroid or ovarian cyst
• Urodynamics - Specialised computerised bladder tests to diagnose stress and/or urge incontinence of urine with or without abnormal bladder contractions; different types of voiding difficulty. The results would determine the treatment options, especially when surgery is planned for stress urinary incontinence and/or pelvic organ prolapse.

The treatment is tailored according to the cause(s) of the OAB:

• Conservative treatment with sensible fluid intake, reduction of coffee, tea and alcohol
• Regular voiding, pelvic floor (Kegel) exercises to strengthen the pelvic floor muscles
• Local oestrogen cream and/or vaginal pessaries for post-menopausal women
• Prevention and treatment of urinary tract infection
• Medical treatment with various drugs to relax the bladder and reduce/stop abnormal bladder contractions
• Appropriate surgical treatment whenever indicated